Marginal and internal fit of porcelain laminate veneers: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Marginal integrity and internal adaptation are key to the long-term success of porcelain laminate veneers. Evidence for their marginal and internal fit is unclear, and the factors affecting such fit have not been identified.

PURPOSE

The purpose of this systematic review and meta-analysis was to summarize the scientific literature assessing the effects of various parameters on the marginal and internal fit of porcelain laminate veneers.

MATERIAL AND METHODS

An electronic search was conducted to identify all relevant published articles on the fit accuracy of ceramic veneers between January 2000 and June 2021 in the PubMed-MEDLINE, Scopus, Embase, Google Scholar, and Web of Science databases. Information, including the study outcomes, in terms of the mean marginal gap, internal gap, and absolute marginal discrepancies of porcelain laminate veneers, was extracted from the selected studies. The inverse-variance random effects model was used to analyze the pooled results and estimate the overall effect based on the heterogeneity of studies (α=.05).

RESULTS

Twenty-one studies were selected for analysis, 2 clinical and 19 in vitro. The risk of bias was "medium" for most studies (19 of 21), and only 2 studies were classified as "high risk." A mean difference of -4.53 μm (95% CI: -21.46 to 12.41) was found, with no statistically significant difference in marginal gap between the pressed and milled fabrication modes (P=.600). As for the internal gap, significant differences were found (mean difference=-40.56 μm; 95% CI: -76.54 to -4.58), with pressed veneers performing better (P=.030). Butt joint preparation design produced significantly (P=.002) lower marginal gaps than the palatal chamfer (mean difference=-14.02 μm; 95% CI: -23.07 to -4.98).

CONCLUSIONS

No significant differences were found between the pressed and milled porcelain laminate veneers for marginal gap, but for the internal gap, the differences were significantly in favor of the pressed type. The butt joint veneer preparation design was significantly better than the palatal chamfer design in terms of marginal fit.

Comparison of Radiographic and Clinical Status and Peri-implant Crevicular Fluid Prostaglandin E2 Levels Among Patients with Peri-implant Mucositis and Peri-implantitis

The aim of this study was to compare radiographic and clinical status and peri-implant sulcular fluid (PISF) prostaglandin E2 (PGE2) levels among patients with and without peri-implant disease. Patients with peri-implant mucositis (PiM) (Group 1) and peri-implantitis (Group 2) and individuals without peri-implant disease (Group 3) were included. Demographic information was collected, and peri-implant modified plaque and bleeding indices (mPI and mBI), probing depth (PD), and crestal bone loss (CBL) were recorded. PISF samples were collected and PGE2 levels measured. Statistical significance was set at P < .01. A total of 22 patients with PiM, 22 with peri-implantitis, and 23 without peri-implant disease (controls) were included. Scores of mPI (P < .01), mBI (P < .01), and PD (P < .01) were higher in patients with PiM and peri-implantitis than the controls. The volumes of collected PISF were significantly higher in patients with peri-implantitis (P < .01) compared to patients with PiM and the controls. The PISF volume was significantly higher in PiM patients (P < .01) than in the controls. There was a significant correlation between peri-implant PD and PISF PGE2 levels in patients with peri-implantitis (P < .001). Raised PISF PGE2 levels indicate poor peri-implant health; therefore, PGE2 is a potential biomarker for the assessment of peri-implant health status.

Peri-Implant Inflammation in Waterpipe Users and Cigarette Smokers: An Observational Study

OBJECTIVE

The aim of this study was to compare peri-implant clinical and radiographic status and levels of advanced glycation endproducts (AGEs) in peri-implant sulcular fluid (PISF) in waterpipe users and cigarette smokers.

METHODS

Waterpipe users, cigarette smokers, and never smokers were included. Demographic details were collected using a questionnaire. Characteristics of implants (dimensions, jaw location, depth of placement, insertion torque, and duration in function) were recorded. Peri-implant modified plaque and gingival indices (mPI and mGI), probing depth (PD), and crestal bone loss (CBL) were recorded in all groups. Volume of PISF and levels of AGEs were determined using standard techniques. Sample-size estimation was done on data from a pilot investigation, and correlation between clinicoradiographic and immunoinflammatory parameters was assessed using logistic regression models. Probability values <.05 were considered statistically significant.

RESULTS

In all, 25, 25, and 24 cigarette smokers, never smokers, and waterpipe users, respectively, were examined. All participants were male and had comparable mean ages. Cigarette smokers and waterpipe users had a smoking history of 20.2 ± 3.5 years and 18.8 ± 0.6 years, respectively. The mPI (P < .01), CBL (P < .01), PD (P < 0.01), and mGI (P < .01) were significantly higher in cigarette smokers and waterpipe users than never smokers. There was no significant difference in clinicoradiographic status and AGE concentrations in waterpipe users and cigarette smokers. A statistically significant correlation was recorded between AGEs and PD in cigarette smokers (P < .01) and waterpipe users (P < .01).

CONCLUSIONS

Waterpipe usage is not less hazardous to peri-implant tissue health than conventional cigarette smoking. It is imperative to caution patients with dental implants about the detrimental effects of tobacco products on oral health.

Does the severity of untreated dental caries of preschool children influence the oral health-related quality of life?

AIM

To assess the impact of untreated dental caries and its severity on the oral health-related quality of life (OHRQoL) of Kuwaiti preschool children and their caregivers.

METHODS

Participants were 4- and 5-year-old kindergarten children attending preselected public schools from one of the Governorates in Kuwait. Early childhood caries (ECC) was evaluated by clinical examinations and presented using decayed, missed, filled teeth/surface (dmft/dmfs). The clinical consequences of untreated dental caries were assessed using the pufa (pulp, ulcers, fistula, abscess) index for primary teeth. A structured questionnaire obtained demographic information of children and their caregivers. OHRQoL was assessed using the Arabic version of Early Childhood Oral Health Impact Scale (A-ECOHIS).

RESULTS

Among the 334 participants, 171 were kindergarten level-1 (KG1), and 163 were level-2 (KG2). The overall prevalence of dental caries was 78.9% for KG1 children and 67.4% for KG2 children. Decayed teeth were the main component for both dmft (84%) and dmfs (68%). The total mean (SD) pufa score was 0.54 (1.5), and about 19.2% of participants had at least one tooth with pufa > 0. A total of 207 A-ECOHIS were completed. Both family and child impact scores were significantly higher for children with a dmft score of 1 or more (p < 0.001) or with one or more pufa (p < 0.001). Child impact section scores were significantly higher with the increasing degrees of untreated caries (dt) (p = 0.004).

CONCLUSION

The severity of untreated dental caries and caries experience had a negative impact on the OHRQoL of Kuwaiti preschool children and their families. Using the pufa index had provided additional information about the effect of the caries severity on the OHRQoL than assessing the caries experience alone.

The Effect of Nanosilver Sodium Fluoride on the Mechanical and Physiochemical Properties of Artificially Demineralised Dentin

PURPOSE

To synthesise and characterise nanosilver sodium fluoride (NSSF) and assess the effect of applying this formulation in vitro on artificially demineralised root dentin lesions, compared with the application of silver diamine fluoride (SDF), sodium fluoride (NAF) or no treatment, in terms of mechanical, chemical and ultrastructural properties.

MATERIALS AND METHODS

NSSF was prepared using 0.5 wt% chitosan solution. On 40 extracted human molars, the buccal aspect of the cervical thirds of roots were prepared and divided into 4 groups of 10 each: control (no treatment), NSSF, SDF and NaF (n = 10). The specimens were examined using scanning electron microscopy (SEM), atomic force microscopy (AFM), and x-ray photoelectron spectroscopy (XPS). Fourier transform infrared spectroscopy (FTIR), surface and cross-sectional microhardness and nano-indentation tests were performed to determine the mineral and carbonate content, microhardness, and nanohardness, respectively. Statistical analysis was performed to determine the differences between the different treatment groups for the set parameters using parametric and non-parametric tests. Tukey's and Dunnet's T3 post-hoc tests were further used for multiple comparisons between groups (α = 0.05).

RESULTS

The control group (no treatment) was found to have statistically significantly lower mean scores for surface and cross-sectional microhardness compared with all other test groups (NaF, NSSF and SDF) (p < 0.05). Spearman's rank correlation test showed statistically insignificant differences between the mineral-to-matrix ratio (M:M) and carbonate content of all groups (p < 0.05).

CONCLUSIONS

Treatment of root lesions with NSSF yielded comparable results to SDF and NaF under in-vitro conditions.

Dentists' Perspective on the Impact of COVID-19 on the Utilization of Emergency Dental Services in Kuwait: A Cross-Sectional Study

This cross-sectional study intends to evaluate dentists' perceptions of COVID-19's effects on the use of emergency dental care both during and after Kuwait's lockdown periods. A convenience sample of dentists employed by the Ministry of Health's various emergency dental clinics and School Oral Health Programs (SOHP) throughout Kuwait's six governorates were invited to take part in this study. To determine the impact of various demographic and occupational characteristics on the mean perception score of the dentist, a multi-variable model was developed. The study was conducted between June-September 2021, and a total of 268 dentists (61% males and 39% females) participated in this study. When compared to pre-lockdown periods, the overall number of patients seen by dentists had significantly decreased after the lockdown period. After lockdown, there were significantly more cases of acute pulpitis with apical periodontitis, abscesses, and pericoronitis than there were before lockdown (p < 0.05). After the lockdown, a significantly higher percentage of dentists (p < 0.05) reported using fewer droplets-generating procedures to manage patients with dental emergencies. After correcting for the other variables in the model, female dentists (β = 0.146; 95% CI = 0.071 to 1.451) and non-Kuwaiti dentist (β = 0.012; 95% CI = 0.234 to 1.854) had a significantly (p < 0.05) more positive perception of the utilization of dental services than others after adjusting for the other variables in the model. The majority of dentists perceive that the COVID-19 pandemic has had a negative impact on Kuwait's use of emergency dental services.

Comparison of periodontal status and salivary IL-15 and -18 levels in cigarette-smokers and individuals using electronic nicotine delivery systems

BACKGROUND

It is hypothesized that periodontal status is compromised and whole salivary (WS) interleukin (IL)-15 and IL-18 levels are higher among cigarette-smokers and electronic-nicotine-delivery-systems (ENDS)-users than never-smokers. The aim of the present case-control study was to compare the periodontal status and WS IL-15 and -18 levels among cigarette-smokers, ENDS-users and controls (never-smokers).

METHODS

Participants were divided into 4 groups as follows: Group-1:Current cigarette-smokers; Group-2:ENDS-users; Group-3:Never-smokers with periodontitis; and Group-4: Never-smokers without periodontitis. Demographic data was collected and plaque index (PI), gingival index (GI), probing-depth (PD), clinical attachment-loss (AL), and marginal bone loss (MBL) were measured. Number of missing teeth were recorded and WS IL-15 and IL-18 levels were determined. Group-comparisons were done and P < 0.01 was selected as an indicator of statistical analysis.

RESULTS

Nineteen, 18, 19 and 19 individuals were enrolled in groups 1, 2, 3 and 4, respectively. Scores of PI, clinical AL, PD, and number of missing-teeth were elevated in groups 1(P < 0.001), 2 (P < 0.001) and 3 (P < 0.001) than -4. Scores of PI, clinical AL, PD, MBL and missing teeth were comparable among patients in groups 1, 2 and 3. Levels of IL-15 and IL-18 were elevated in groups 1 (P < 0.001) and 2 (P < 0.001) than groups 3 and 4. The levels of IL-15 and -18 were higher in Group-3 than in Group-4 (P < 0.001).

CONCLUSION

Clinically, cigarette-smokers and never-smokers demonstrate similar periodontal statuses; however, WS immunoinflammatory biomarkers (IL-15 and -18) are elevated in these individuals than non-smokers.

Increased expression of advanced glycation endproducts in the gingival crevicular fluid compromises periodontal status in cigarette-smokers and waterpipe users

Background

The aim was to assess the association between levels of advanced glycation endproducts (AGEs) in the gingival crevicular fluid (GCF) and periodontal parameters among cigarette-smokers and waterpipe-users.

Methods

Self-reported cigarette-smokers; waterpipe-users and never-smokers were included. Demographic data was recorded using a questionnaire. Periodontal parameters (plaque index [PI], gingival index [GI], clinical attachment loss [AL], probing depth [PD], and marginal bone loss [MBL]) were assessed in all groups. The GCF samples were collected using standard techniques and assessed for AGEs levels using enzyme-linked immunosorbent assay. Sample-size estimation was done and group-comparisons were done. Correlation between levels of GCF AGEs levels and periodontal parameters was assessed using a logistic regression model. Level of significance was set at P < 0.01.

Results

Eighty-two individuals (28 cigarette-smokers, 28 waterpipe-users and 26 never-smokers) were included. There was no difference in mean ages of all patients. Cigarette-smokers had a smoking history of 5.1 ± 0.2 pack years and waterpipe-users were using waterpipe for 4.4 ± 0.6 years. There was no statistically significant difference in PI, GI, clinical AL, PD and MBL in all groups. Levels of AGEs were significantly higher among cigarette-smokers (P < 0.001) and waterpipe-users (P < 0.001) than never-smokers. There was no significant correlation between levels of GCF AGEs levels and periodontal parameters in all groups.

Conclusion

Clinical periodontal status of individuals with a short history of cigarette-smoking and waterpipe-usage may appear similar to never-smokers. On a molecular level, cigarette-smoking and waterpipe-users express raised levels of AGEs than never-smokers that sirens about the ongoing yet latent periodontal inflammatory process.

Cortisol Levels in the Peri-implant Sulcular Fluid of Type-2 Diabetic and Non-diabetic Patients with Peri-implantitis

PURPOSE

Cortisol levels (CL) in peri-implant sulcular fluid (PISF) samples in relation to type-2 diabetes mellitus (T2DM) and peri-implantitis remain unaddressed. It is hypothesi?sed that PISF CL are higher in patients with type-2 diabetes and peri-implantitis than in healthy patients without and with peri-implantitis. The aim was to assess the PISF CL of peri-implantitis patients without and with T2DM.

MATERIALS AND METHODS

Peri-implantitis patients with T2DM (group 1), T2DM patients without peri-implantitis (group 2), non-diabetic patients with peri-implantitis (group 3) and non-diabetic patients without peri-implantitis (group 4) were included. Demographics were recorded; and patients' medical and dental records were assessed. Peri-implant modified plaque-index (mPI), modified gingival index (mGI), and probing depth (PD) and crestal bone loss (CBL) were recorded. The PISF was collected and CL were determined. p < 0.01 was considered statistically significant.

RESULTS

Each of the four groups included 16 subjects (n = 64) with no difference in mean age. In groups 1 and 2, the mean duration of T2DM was 10.5 ± 0.8 and 10.6 ± 0.4 years, respectively. Mean HbA1c levels (p < 0.01) were higher and clinicoradiographic parameters (p < 0.001) were worse in group 1 than in the other groups. The median PISF volume and mean CL were higher in groups 1 (p < 0.01) and 3 (p < 0.01) than groups 2 and 4. There was a statistically significant correlation between PD and CL in group 3 (p < 0.001).

CONCLUSION

Cortisol levels in the PISF are higher in T2DM and non-diabetic patients with peri-implantitis than in healthy individuals with and without peri-implantitis. Hyperglycemia did not influence peri-implant clinicoradiographic parameters and CL in the present patient population.

Association between the caregivers’ oral health literacy and the oral health of children and youth with special health care needs

Aim

Previous studies have shown that children of caregivers with low oral health literacy (OHL) had more untreated caries than children of caregivers with adequate OHL. However, there is a paucity of information on this relationship among children and youth with special health care needs (CYSHCN). Accordingly, this study aims to assess the association between the caregivers’ OHL and the oral health status of CYSHCN.

Methods

This cross-sectional study was conducted in four schools dedicated for CYSHCN. A 48-item questionnaire gathered information about the demographic and socioeconomic factors, the child/adolescent’s medical condition, dental characteristics, caregiver self-efficacy and the child’s dental attitude. The Comprehensive Measure of Oral Health Knowledge (CMOHK) questionnaire was used to assess the caregivers’ OHL. The Löe & Silness gingival index (GI) and the Silness & Löe plaque index (PI) were used to assess gingival health and plaque levels, respectively. Directed acyclic graphs (DAGs) were utilized for the selection of the appropriate set of confounding variables for regression analysis. The mean score differences and 95% confidence intervals (CI) were estimated to quantify the associations of the various covariates with oral health outcome variables.

Results

This study included 214 child/caregiver dyads. Most participants were physically disabled (56.1%) followed by children with hearing difficulty (9.8%) and congenital anomalies/syndromes (7.9%). The mean PI and GI of the children was 1.26±0.52 and 1.30±0.47, respectively. The median CMOHK score was 12 and the respondents were dichotomized based on the median value. Low caregiver oral health conceptual knowledge was significantly associated with higher PI scores (β [95% CI] = -0.26 [-0.41, -0.13]; p<0.001. Older participants (12-21-year-olds) had significantly higher plaque scores compared with younger participants (6-12-year-olds) (β [95% CI] = 0.33 [0.18, 0.51]; p<0.001). Participants who brushed their teeth twice or more daily had significantly lower (β [95% CI] = -0.15 [-0.43, -0.01]; p = 0.046). Conceptual knowledge score was not significantly associated with GI.

Conclusion

This study found lower caregiver OHL levels to be associated with higher plaque scores for their child.

Association between Frequency of Toothbrushing and Metabolic Syndrome among Adolescents: A 5-Year Follow-Up Study

This study longitudinally examines the relationship between the frequency of toothbrushing and the development of selected components of metabolic syndrome (MetS), along with the potential role of salivary biomarkers in this relationship. In 2014, 6317 12-year-old children underwent health examinations (T1), of which, 348 children participated in the second stage of data collection in 2019 (T2). The association between the change in the metabolic status during the 5-year follow-up examination (between T1 and T2) and frequency of toothbrushing was assessed using multinomial logistic regression analyses. At T2, healthy adolescents had significantly higher odds of toothbrushing twice or more daily compared with adolescents with components of MetS (OR = 1.99, 95% CI 1.15–3.45). Adolescents who were healthy at T1 but developed components of MetS at T2, had significantly higher frequencies of dining-out compared with adolescents with components of MetS at both T1 and T2 (OR = 0.09, 95% CI 0.02 to 0.49). Adolescents who were ‘healthy’ at both T1 and T2 had significantly (p < 0.05) lower levels of C-reactive protein (T2), insulin (T1 and T2), interleukin-6 (T1) and adiponectin (T1) compared with adolescents who had components of MetS. Toothbrushing and frequency of dining-out were associated with the presence of MetS components.

Epidemiological characteristics of COVID-19 cases among Indians residing in Kuwait

Background

The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread to most countries around the world. Disproportionate spread of COVID-19 among the Indian community in Kuwait prompted heightened surveillance in this community.

Aims

To study the epidemiological characteristics of COVID-19 patients and their contacts among the Indian community in Kuwait.

Methods

Data collection was done as a part of contact tracing efforts undertaken by the Kuwaiti Ministry of Health.

Results

We analysed contact-tracing data for the initial 1348 laboratory-confirmed Indian patients and 6357 contacts (5681 close and 676 casual). The mean (standard deviation) age of the patients was 39.43 (10.5) years and 76.5% of the cases were asymptomatic or had only mild symptoms. Asymptomatic patients were significantly older [40.05 (10.42) years] than patients with severe symptoms [37.54 (10.54) years] (P = 0.024). About 70% of the patients were living in shared accommodation. Most of the close contacts were living in the same household, as compared with casual contacts, who were primarily workplace contacts (P < 0.001). Among the different occupations, healthcare workers had the highest proportion of cases (18.4%). Among the 216 pairs of cases with a clear relationship between the index and secondary cases, the mean serial interval was estimated to be 3.89 (3.69) days, with a median of 3 and interquartile range of 1-5 days.

Conclusion

An early increase in the number of COVID-19 cases among the Indian community could be primarily attributed to crowded living conditions and the high proportion of healthcare workers in this community.

Neurotic personality trait as a predictor in the prognosis of composite restorations: A 24-month clinical follow up study

The role of personality traits in modulating the incidence and progression of medical disease conditions are well documented, however, there is a paucity of information for its effects on dental health conditions and specifically on the prognosis of restorative dental materials. This study aims to evaluate the clinical performance of Micro-hybrid and Nano-ceramic composite restorations among patients with different personality traits. A total of 323 patients, indicated to receive operative treatment at a University Dental College Hospital, were invited to participate in this study. Consenting patients were requested to complete the Big Five Inventory (BFI-44 Item) personality questionnaire and were evaluated by a psychiatrist for categorizing the participants based on their personality traits. Out of the recruited patients, 124 patients falling in to the dominant trait of Agreeableness (n = 62) and Neuroticism (n = 62) were included in the study for further investigation. Next, patients from the Agreeableness (Group A) and the Neuroticism personality trait group (Group N) were randomly divided into two subgroups each—sub group Am (n = 44) and Nm (n = 48) for Micro-hybrid composite restorations and Sub group An (n = 42) and Nn (n = 47) for Nano-ceramic composite restorations. Two trained and calibrated dentists prepared the cavities according to previously published methodology. The restorations were evaluated at baseline (immediately after restoration), 6-months, 12-months and 24-months intervals by two blinded independent dental professionals for anatomical form, secondary caries, color match, retention, marginal adaptation, surface texture, marginal discoloration and post-operative sensitivity. There is no statistically significant difference noted in various parameters of restoration performance between Micro-hybrid composite and Nano-ceramic composite compared among ‘agreeableness’ personality group and among ‘neuroticism’ personality group after controlling the personality trait factor. Higher ‘Neuroticism’ individuals had higher restoration deterioration in color matching and surface texture when compared to higher ‘Agreeableness’ trait individuals. Regression analysis showed no effect of gender or cavity size on the outcome of results. Assessment of personality traits may serve as a useful tool during treatment planning which would aid clinicians in choosing suitable restorative dental material and prosthesis design according to individual patient’s physiological and functional needs, thereby overall improving the quality of treatment provided.

Dental Education in an Era of COVID-19: Kuwait's Experience

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on dental education worldwide. Due to the rapid spread of COVID-19 across Kuwait, it was essential for the Faculty of Dentistry (FoD) at Kuwait University to make appropriate modifications to the functioning of the dental school. The FoD's goal was not only to ensure a safe environment for its staff, students, and patients but also to sustain the students' academic progression. The FoD adopted several measures including the establishment of a COVID-19 response team, adoption of a blended-learning model, and phase-wise re-opening of the dental center. This paper discusses on the strategies that the FoD adopted, in response to the challenges posed by the pandemic.

Pattern of Traumatic Dental Injuries Among Adults

Background

The etiology, presentation and management of traumatic dental injuries (TDIs) vary significantly between the adult and the younger population. Most epidemiological studies on TDIs have focused on the pediatric age group. This study aims to report and compare the distributions of TDIs among adults in a sub-population in India.

Methods

This prospective observational study was performed on 1562 consecutively selected patients (1218 males and 344 females) from a university dental hospital in India, between July 2014 and June 2018. The clinical examinations were performed by a single trained and calibrated endodontist. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible) and classified using a modified version of the World Health Organization's (WHO’s) classification. Periapical and panoramic radiographs were taken for all the subjects.

Results

A total of 1562 patients aged between 20 and 73 years, with a mean age of 36 years, were examined during the study period. The total number of teeth with TDIs was 3044. Males (78%) clearly outnumbered the females (22%) in all the age groups. The most common type of injury occurring in both the genders is uncomplicated crown fractures (male=31.0% and female=36.6%). Avulsion injuries are more likely to be seen by a dentist within 1 hour post-trauma. About two-third of the TDIs were caused by road traffic accidents (RTAs) followed by falls in about 20% of the patients.

Conclusion

Uncomplicated crown fracture was the most commonly observed type of TDI, and RTAs were the primary cause of TDI.

Periodontal Clinicoradiographic Status and Whole Saliva Soluble Urokinase Plasminogen Activation Receptor and Tumor Necrosis Factor Alpha Levels in Type-2 Diabetic and Non-diabetic Individuals

PURPOSE

The authors hypothesise that whole saliva soluble-urokinase-type plasminogen-activator receptor (suPAR) and tumor necrosis factor-alpha (TNF-α) levels are higher in patients with poorly-controlled than well-controlled type-2 diabetes mellitus (DM) and non-diabetic controls. The aim was to assess the periodontal clinicoradiographic status and whole-salivary suPAR and TNF-α levels in type-2 diabetic and non-diabetic individuals.

MATERIALS AND METHODS

Patients with and without type-2 DM were included. In all patients, hemoglobin A1c (HbA1c) levels were measured. Participants were divided into 4 groups. Group 1: patients with poorly controlled type-2 DM; group 2: patients with well-controlled type-2 DM; group 3: non-diabetic patients with periodontitis; group 4: non-diabetic patients without periodontitis. Clinicoradiographic periodontal parameters (plaque index [PI], gingival index [GI], clinical attachment loss [AL], probing depth [PD] and mesial and distal marginal bone loss [MBL]) were measured. The whole saliva total protein concentration (TPC) and suPAR as well as TNF-α levels were measured. The level of statistical significance was set at p < 0.01.

RESULTS

One hundred patients (25 patients per group) were included. Scores of PI (p < 0.01), GI (p < 0.01), clinical AL (p < 0.01), PD (p < 0.01), number of missing teeth and mesial (p < 0.01) and distal (p < 0.01) MBL were statistically significantly higher in group 1 than in groups 2-4. Scores of PI, GI, clinical AL, PD, mesial and distal MBL, and numbers of missing teeth were higher in group 3 (p < 0.01) than in groups 2 and 4. The whole saliva TPC, suPAR and TNF-α levels were statistically significantly higher among patients in group 1 (p < 0.01) than in groups 2-4.

CONCLUSION

Patients with poorly-controlled type-2 DM presented with poorer clinicoradiographic periodontal status and increased whole saliva levels of suPAR, TNF-α and TPC compared with patients with well-controlled type-2 DM and non-diabetic individuals.

A clinical investigation into the efficacy of miswak chewing sticks as an oral hygiene aid: A crossover randomized trial

OBJECTIVES

This study evaluates the effect of using miswak chewing sticks on dental plaque, selected oral microbiota and gingival inflammation among patients with gingivitis.

METHODS

The study was a single-centre, single-examiner blind, randomized, crossover study. Twenty healthy participants were randomly assigned into two equal groups (n = 10). Group 1 were instructed to use both toothbrush and miswak (TB+M) for the first 2 weeks from baseline (T1) and only toothbrush for the next 2 weeks (T2); and Group 2, only TB during T1 and TB+M during T2. Gingival index (GI), plaque index (PI) and bleeding on probing (BOP) were evaluated at baseline (T0), T1 and T2 visits. Supra-gingival plaque samples were taken at T0, T1 and T2. Quantification of Streptococcus mutans and Aggregatibacter actinomycetemcomitans from the supra-gingival plaque samples were performed by real-time polymerase chain reaction (qPCR).

RESULTS

The scores of GI, PI and BOP had significantly improved for both groups between T0 and T1. A significantly greater reduction in the percentage of sites with BOP was observed for TB+M group compared with TB group (TB+M group: from 32.2 to 14.93; TB group: from 34.00 to 26.0; p = .014). At T2, TB+M group had significant improvements (p < .05) in the PI, GI and BOP scores compared with TB group. There was no significant difference in the microbial counts of S. mutans and A. actinomycetemcomitans between the two groups at the end of the study period.

CONCLUSIONS

Oral hygiene and gingival health may be improved by complementing miswak chewing sticks with toothbrushing.

Sociodemographic and behavioural determinants of early childhood caries knowledge among expectant mothers in Kuwait

PURPOSE

Early Childhood Caries (ECC) is a highly prevalent disease in Kuwait. It poses health, economic, and social implications affecting patients, their families and communities. ECC awareness campaigns targeting expectant mothers hold a promising potential as primary prevention tools. Understanding the baseline of ECC knowledge (ECC-K) is an important foundational step in planning such interventions. The aim of this study was to assess the level of ECC-K in a sample of expectant mothers, and to identify the sociodemographic and behavioural determinants of that knowledge.

METHODS

A multiple-choice questionnaire was distributed to 430 expectant women from one maternity hospital in Kuwait. The questionnaire gathered information on the demographics, ECC-K, and the oral health behaviours of the participants. Bivariate analysis assessed the relationship between ECC-K scores and the different socio-demographic variables and oral health practices of the participants. A multiple linear regression model was developed to identify the predictors of ECC-K scores RESULTS: The response rate was 94% (n = 405). The mean ECC-K score was 6.4 [standard deviation (SD) = 2.5] out of a maximum score of 14. Age, education, number of children, frequency of dental visits, and flossing frequency were significantly associated with ECC-K levels (p < 0.05).

CONCLUSIONS

ECC-K among this cohort of expectant mothers was inadequate. Educational interventions are needed to foster better ECC preventive practices.

Peri-implant mucosal response to implant-supported overdentures: A systematic review and meta-analysis

OBJECTIVES

To systematically review and evaluate the effects of different types of attachments, implant numbers and loading protocols on the peri-implant mucosa of implant-supported overdentures (ISODs).

BACKGROUND

The impact of peri-implant tissue health on the ISOD treatment outcome is unclear, and current evidence is inadequate on this aspect.

MATERIALS AND METHODS

A systematic literature search for randomised controlled trials or prospective studies was conducted in indexed databases from 1995 to April 2020. The focused question was as follows: How does the peri-implant mucosa respond to implant-supported or implant-tissue-supported complete overdentures based on different types of attachments, implant numbers, and loading protocols, in terms of clinical outcomes achieved [plaque index (PI), gingival index (GI), probing pocket depth (PD) and bleeding index (BI)]? A random- or fixed-effects model was applied to measure the significance of standardised mean differences (SMD) of PD between the groups.

RESULTS

Seventeen studies met the eligibility criteria. The SMD for PD between splinted/bar and unsplinted/stud attachments was 0.10 mm (95% CI: -0.27 to 0.47; P = .60) and between 2- and 4-implant groups was 0.15 mm (95% CI: -0.16 to 0.45; P = .34), which were not statistically significant. Significant difference (P = .003) was observed between immediate/early loading and delayed loading (SMD = 0.46 mm [95% CI: 0.16 to 0.75]).

CONCLUSIONS

Probing depth for the immediate loaded implants was significantly higher than for the delayed loading group. No attachment type, implant number or loading protocol seemed to have a clear advantage over the other, in terms of other peri-implant mucosal outcome measures.

Utilization of dental services among low and middle income pregnant, post-partum and six-month post-partum women

Background

This study aims to explore the difference in the utilization pattern of dental services among pregnant, post-partum and six-month post-partum women.

Methods

This cross-sectional questionnaire survey was performed at two maternity and child care hospitals in India that primarily cater to middle and low income communities. Data were collected from 3 groups: 1) pregnant women in their first trimester; 2) post-partum women (< 48 h after delivery); and 3) six-month post-partum women. The primary outcome of interest was dental service utilization during pregnancy. Self-perceived oral health (SPOH) was calculated based on the four global dimensions- knowledge, function, quality of life and social. Multiple logistic regression analysis was carried out to assess the effect of each independent variable after adjustment for the effect of all other variables in the model.

Results

Responses of 450 (150 pregnant, 150 post-partum and 150 six-month post-partum) women were analyzed (response rate = 72%). Significant differences in the dental attendance pattern was observed between the study groups (p < 0.01). Dental attendance among pregnant and six-month post-partum women were 60 and 75%, respectively, however, only about 15% of the post-partum women reported to have sought dental care within the 6 months prior to the study. Post-partum women had the highest SPOH scores, indicating poor self-perceived oral health, followed by pregnant and then six-month post-partum women, which was statistically significant (p < 0.05). A significantly higher percentage of post-partum women reported to have poor oral and general health, as compared to both, pregnant and six-month post-partum women (p < 0.01). Higher percentage of women reporting ‘good’ oral and general health had sought dental care compared with others (p < 0.01). After adjusting for all the other variables in the model, women with lower levels of education (OR^a = 1.42; 95% CI: 1.01–2.00), women with poor self-perceived oral health (OR^a = 1.08; 95% CI: 1.02–1.14) and post-partum women (OR^a = 0.15; 95% CI: 0.09–0.24) were found to be less likely to seek regular dental care.

Conclusion

Pattern of dental service utilization among women in this population varied according to their pregnancy status, level of education and self-perceived oral health.

Perception of general dentists and laypersons towards altered smile aesthetics

OBJECTIVES:

This study aimed to evaluate how dental practitioners and laypersons differ in their perception of altered smile aesthetics based on viewing images of a digitally manipulated smile.

MATERIALS AND METHODS:

A photograph with close to ideal smile characteristics was selected and digitally manipulated to create changes in buccal corridor space (BCS), midline diastema, gingival display, and midline shift. These altered images were rated by two groups: dental practitioners and lay persons using a visual analogue scale. The mean ± standard deviation (SD) of both groups were calculated and the Student's t-test was used to identify any statistically significant differences between the groups. Data analysis was done using the Statistical Package for Social Science (version 23.0; SPSS Inc., Chicago, Illinois, USA).

RESULTS:

The dentists were more sensitive to changes in the midline shift than laypeople and provided lower scores. There were no significant differences between the two groups when the gingival display alteration was ≤3 mm. However, for gingival display of 4 mm and 5 mm, there was significant difference between the two groups, with dentist rating them poorer as compared with the laypeople (P < 0.001). Dentists were more sensitive than the laypeople for midline diastema of 2 mm and 3 mm (P < 0.001 and P = 0.005 respectively). Changes in the BCS had minimal impact on the overall esthetic score for both the groups.

CONCLUSIONS:

Perception of smile esthetics differed between dentists and laypersons.

Influence of Lifestyle on Dental Health Behavior

Background

Lifestyle is a general way of living, which is based on the interplay between living conditions, and individual patterns of behavior as determined by socio-cultural factors, and personal characteristics. There is a paucity of studies assessing the role of various factors, including lifestyle, on the dental health behavior. The present study aims to determine the factors that influence the dental health behavior among a subgroup of adult patients attending a tertiary care center in Riyadh, Saudi Arabia.

Methods

This cross-sectional questionnaire survey was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. The questionnaires were distributed to a convenient sample of 300 individuals, which gathered information on the socio-demographic data, lifestyle and dental health behaviors. Bivariate analyses were used to explore the associations between each of the covariates and p-value < 0.05 was considered to be statistically significant. Multivariate logistic regression model was built using backward stepwise method for the dependent variable ‘dental behavior’.

Results

Of the 300 questionnaires that were distributed, 279 were returned completed (response rate = 93%). The majority of our samples were Saudis (73.1%) and females (54.1%), with more than half the respondents having completed baccalaureate degree (55.2%) and about a quarter with either Masters or PhD. The mean age ± SD of the respondents was 35 ± 9.1 and the median age of ‘32 years’ was used to categorize the age (≤32 and > 32). Multivariate logistic regression analysis showed that gender (OR^a = 2.84; 95% CI: 1.63–4.95), age (OR^a = 0.51; 95% CI: 0.3–0.87) and lifestyle (OR^a = 1.4; 95% CI: 1.18–1.68) were independently associated with dental behavior after adjusting for all the other variables. Age, gender and nationality were also found to be significantly associated with lifestyle (p < 0.01).

Conclusion

Older adults, women and individuals with a healthy lifestyle were found to be significantly associated with positive dental behaviors.

Relationship between Caregivers' Oral Health Literacy and their Child's Caries Experience

OBJECTIVE

This study aimed to assess the association between caregivers' oral health literacy (OHL) and the dental caries experience of their child.

PARTICIPANTS

This cross-sectional study was conducted among 300 caregiver/child dyads at a paediatric dental centre in Saudi Arabia. The OHL was assessed using an Arabic translated version of Comprehensive Measure of Oral Health Knowledge (CMOHK-A) questionnaire. Test-retest reliability and internal consistency was assessed using the appropriate statistical methods.

MAIN OUTCOME MEASURE

Childrens' dental caries experience was assessed using the DMFT and deft index (decayed, missing/extracted, filled teeth) for permanent and primary teeth respectively.

RESULTS

The mean age of the caregivers and children was 37.9±7.9 years and 8.3±3.1 years respectively. Most children (87.7%) had dental caries experience (dmft ⟩ 0) and the mean DMFT/deft was 5.2±4.0. The means±standard deviations (SD) for untreated caries (DT/dt), missing/extracted teeth (MT/et) and filled teeth (FT/ft) were 2.6±2.5, 0.5±0.9 and 2.1±2.2 respectively. Multivariate linear regression models showed that caregivers educational levels and OHL scores were associated with the child's untreated caries levels. Caregivers' gender, educational levels and their perception of the child's oral health were significant predictors for child's lifetime caries experience. Children of caregivers with low OHL had more untreated caries than children of caregivers with adequate OHL.

CONCLUSION

This study found better caregiver OHL levels to be associated with lower caries experience for their child.

Relationship between oral health literacy and oral health status

Background

Health literacy has been found to be a strong predictor of an individuals’ health, health behavior and health outcomes. Lower literacy has been linked to problems with the use of preventive services, delayed diagnoses of medical conditions, poor adherence to medical instructions, poor self-management skills, increased mortality risks, poor health outcomes, and higher health care costs. The aim of this study is to determine the relationship between oral health literacy (OHL) and oral health status among patients attending a University-affiliated dental clinic.

Methods

A convenience sample of participants was drawn from the dental patients presenting at School of Dental Medicine (SODM), Case Western Reserve University (CWRU). Information about the subjects’ demographic details, income, family size, insurance type and smoking history were collected using a data collection form. Data about the patients’ periodontal and caries risk assessment, caries experience and periodontal status was extracted from the patients’ electronic dental records. The Comprehensive Measure of Oral Health Knowledge (CMOHK) was used to record the oral health literacy. The median CMOHK score was 18, and this was used to categorize the sample into limited OHL (≤18) and adequate OHL (> 18) groups. A multivariate logistic regression model was built to examine the associations between the various independent variables and OHL levels.

Results

Data of 150 respondents were analyzed. More than half of the participants were female (55.3%) and the majority were Caucasian (60%). The average age of participants was 53.3 years [standard deviation (SD) 16.8]. Higher percentage of African Americans and individuals with low education had limited OHL levels (p < 0.05). The mean decayed, missing, and filled teeth (DMFT) score for this population was 7.33 ± 2.68. Subjects with limited OHL had significantly higher mean values for missing teeth (p < 0.05) and lower mean values for filled teeth (p < 0.05) as compared with subjects with adequate OHL Significantly, higher percentage of subjects with limited OHL had severe periodontitis as compared with those with adequate OHL (p = 0.04). Multivariate analysis found that the periodontal status was significantly associated with the OHL scores (p = 0.015).

Conclusion

Subjects with limited OHL levels had poorer periodontal health. Improving the OHL of patients may help in the efforts to improve the adherence to medical instructions, self-management skills and the overall treatment outcomes. Future research could focus on assessing the impact of OHL interventions on the oral health, which could be valuable for clinical practitioners.

Ex vivo fracture resistance of teeth restored with glass and fiber reinforced composite resin

OBJECTIVES

This study aims to compare the ex vivo fracture resistance of root canal treated (RCT) teeth restored with four different types of fibers under composite resin.

SUBJECTS AND METHODS

One hundred and forty extracted mandibular first molar teeth were assigned to seven groups (n = 20/group). Group 1 was the control group. In groups 2-7, endodontic access and standard Mesio-occluso-distal (MOD) cavities were prepared. Following RCT, group 2 was left unrestored. In group 3, flowable composite resin (FCR) was used to line the cavities and restored with composite resin. In groups 4,5,6 and 7, Ribbond, Everstick, Dentapreg and Bioctris fibers were inserted in flowable resin and restored respectively.

RESULTS

All the groups restored with fiber reinforced composite displayed higher fracture resistance than the group restored with only composite resin (p < 0.001). In addition, Groups restored with Everstick and Bioctris (Groups 5 and 7) showed higher fracture resistance when compared to Ribbond and Dentapreg (Groups 4 and 6).

CONCLUSION

E glass fibers demonstrated highest fracture resistance and hence can be preferred over other fiber types to reinforce RCT teeth with weakened crown structures.

Radiographic Diagnosis of Periapical Status and Quality of Root Canal Fillings in a Saudi Arabian Subpopulation

PURPOSE

To assess the prevalence of apical periodontitis (AP), as determined by orthopantomograms (OPGs), and its correlation with the quality of root fillings and coronal restorations.

MATERIALS AND METHODS

This cross-sectional study evaluated a random sample of 193 patients--112 (58%) females and 81 (42%) males--who presented as new patients at the Division of Endodontics. Digital OPGs were independently examined by two reliability-calibrated endodontists. The total number of teeth present, the location of the root canalfilled teeth, and the presence or absence of AP were recorded for each radiograph. The results were statistically analysed using the chi-square test followed by model building using multiple logistic regression.

RESULTS

A total of 324 endodontically treated teeth from the 193 selected radiographs were analysed. The mean number of teeth per patient was 25.5 ± 4.6, with an average of 1.64 root canal treatments per subject. Radiographically detected AP was associated with 190 (58.6%) root canal-treated teeth. The logistic model shows that the quality of endodontic treatment (adjusted odds ratio [ORa] = 1.82; 95% confidence interval [CI]: 1.40-3.17), status of coronal restoration (ORa = 1.77; 95% CI: 1.20-2.61) and the type of material used for coronal restorations (ORa = 1.39; 95% CI: 1.03-1.87) were significantly related to the periapical health of the teeth.

CONCLUSIONS

The quality of endodontic treatment, status of coronal restoration and the type of coronal restorative material were found to be the most important factors influencing the health of periradicular tissue.

The association between oral health literacy and missed dental appointments

BACKGROUND

In this study, the author identified associations among demographic characteristics, dental risk factors, health-seeking behaviors, oral health literacy level, and failure to keep dental appointments.

METHODS

The author conducted an unmatched 1:2 case-control study at a university-based dental clinic from February through April 2015. The author used the Comprehensive Measure of Oral Health Knowledge questionnaire to record the oral health literacy of the respondents. The author obtained additional information about the various covariates using a questionnaire and checking the patients' electronic medical records. The author used a multivariate logistic regression analysis to test the associations between missed appointments and other risk factors in addition to oral health literacy.

RESULTS

Data from 150 (50 case patients and 100 control patients) respondents were included in the analysis. The case and control patients were comparable in terms of sociodemographic characteristics and dental risk factors. The Comprehensive Measure of Oral Health Knowledge score was used to categorize the sample into low (≤ 18) and high (> 18) oral health literacy groups. Low oral health literacy was associated with a 2-fold increase in the risk of having missed appointments (adjusted odds ratio, 2.38; 95% confidence interval, 1.05-5.40). Age was also independently associated with missed appointments (adjusted odds ratio, 1.03; 95% confidence interval, 1.01-1.06).

CONCLUSIONS

After adjusting for the various demographic and dental risk factors, poor oral health literacy was found to be independently associated with missed dental appointments. Insights into the role of oral health literacy and clinic attendance could play an important role in addressing the problem of missed dental appointments.

PRACTICAL IMPLICATIONS

Considering the effects of missed appointments on treatment outcomes, predictors of patient compliance behaviors may be useful in circumventing cancellations and no shows.

Flapless Dental Implant Surgery for Patients on Oral Anticoagulants—The “WarLess Procedure”: A Report of 2 Cases

Patients with prosthetic heart valves are maintained on lifelong oral anticoagulant therapy. The optimal anticoagulant management of such patients during surgical dental procedures has been debated for a long time. Compared with conventional dental implant placement, a minimally invasive flapless approach has the potential to reduce bleeding and minimize surgical time, postoperative pain, soft tissue inflammation, and crestal bone. The purpose of these case reports is to show the clinical predictability of dental implant placement using a minimally invasive flapless approach without reducing the dosage of anticoagulants for patients on lifelong anticoagulant therapy. In this study, a 45-year-old woman and a 58-year-old man who had undergone cardiac surgery and were currently under a full therapeutic level of anticoagulation therapy (warfarin) were treated with flapless dental implant surgery without reducing their anticoagulant dosage. Postoperative clinical and radiographic assessment showed no abnormality, minimal signs of inflammation, and excellent healing. The combination of minimally invasive flapless dental implant surgery with no interruption in the normal dose of the anticoagulant medications could be an improved method for placing dental implants in patients on long-term anticoagulant therapy.

The prevalence of oral Candida infections in periodontitis patients with type 2 diabetes mellitus

OBJECTIVES

The purpose of this study was to determine the prevalence of Candida spp. in periodontitis patients with type 2 diabetes mellitus.

METHODS

This cross-sectional study included 42 diabetic patients with periodontitis (aged 21-70 years; 18 males and 24 females). Clinical measurements included probing pocket depth (PPD), clinical attachment level (CAL) and hemoglobin A1c (HbA1c) levels. Sub-gingival samples were collected from the mesio-buccal aspect of 3 teeth for fungal analysis. Candida species, including Candida albicans, Candida dubliniensis, Candida tropicalis and Candida glabrata, were identified using Gram staining, the germ tube test, CHROMagar, Staib agar and API 20C AUX.

RESULTS

The overall prevalence of Candida in diabetic patients with periodontitis observed in our study was 52%. The most common spp. of Candida identified were C. albicans (38%), followed by C. dubliniensis (9.5%), C. tropicalis (4.7%) and C. glabrata (4.7%). Compared to females, male patients were characterized by increased levels of Candida infections. Our results also indicate that individuals over the age of 40 had increased levels of Candida infections compared to patients younger than 40. Candida infections were higher among subjects with elevated blood sugar levels (HbA1c>9) compared to individuals with well-controlled blood sugar levels (HbA1c<6). Patients with PPDs≥5 had an increased risk of Candida infection compared to patients with PPDs between 3 and 4.

CONCLUSION

This study indicates that the frequency of C. albicans is higher than the frequencies of C. dubliniensis, C. tropicalis and C. glabrata in diabetic patients with periodontitis. Candida infections were observed at increased frequencies among subjects with high blood sugar levels and PPDs≥5.

Prevalence of malocclusion and its relationship with caries among school children aged 11 - 15 years in southern India

Objective

To assess the prevalence of malocclusion and its relationship with dental caries among school children in southern India.

Methods

This cross-sectional study included 1,800 students aged 11 - 15 years whose Dental Aesthetic Index (DAI) and dentition status were recorded and analyzed. The chi-square test, ANOVA, and Spearman's correlation tests were carried out.

Results

The mean DAI score ± the standard deviation was 18.61 ± 6.1. Approximately 85% of the students (83.0% males, 86.8% females) had DAI scores of < 26 and were classified as not requiring orthodontic treatment. One tenth of the sample had mean DAI scores between 26 - 30 (indicating definite malocclusion and elective treatment), while about 3% had mean scores between 31 - 35 (indicating severe malocclusion and treatment desirability). Only 29 children (1.6%; 16 boys, 13 girls) had a DAI score of > 35, which suggested very severe or handicapping malocclusion requiring mandatory treatment. The mean decayed, missing, filled teeth (DMFT) was 2.28 ± 1.47. A DMFT of > 0 was observed in 91.8% of the study subjects. Children with a DAI score of > 35 were found to have significantly (p < 0.001) higher caries experience as compared to other children. Moreover, the DAI scores showed a significant correlation with the mean DMFT scores (r = 0.368, p < 0.05).

Conclusions

A positive correlation was found between the severity of malocclusion and dental caries.

Oral health status of 12-year-old school children in Yemen. A cross- sectional survey

AIM

This study aims to describe the oral hygiene practices and the oral health status of 12-year-old school children of Aden, Yemen.

STUDY DESIGN

Multistage stratified cross-sectional survey.

MATERIALS AND METHODS

A cross- sectional survey of randomly selected schools in the city was performed. Four hundred 12-year-old students were recruited in the study from both private (N. 200) and government schools (N. 200). In total 219 boys (54.8%) and 181 girls (45.2%) participated in this study. Scoring of decayed, missing, filled teeth (DMFT) and the Community Periodontal Index (CPI) scores were computed according to the WHO recommendations.

RESULTS

Mean DMFT was 2.22±1.56 and DMFT >0 was seen in 90.2% of the study subjects. The D component of the caries index was dominant and it was clinically evident in 84.7% of the students. Children having high cariogenic food consumption had significantly (P<0.001) higher mean DMFT, DT, MT and FT. Children who used only toothbrush were found to have significantly (P<0.001) lower caries experience as compared to those who used only miswak or those who used both. About 63% of the students has CPI=2 and less than 20% had CPI=0. Children who brushed regularly were found to have better CPI scores. Multivariate analysis showed that diet (ORa = 1.56; 95% CI= 1.82-2.44) was significantly associated with dental caries.

STATISTICS

data were analysed with Statistical Package for Social Sciences for Windows 17.0 (SPSS Inc., Chicago, IL, USA).

CONCLUSION

The overall oral health of the 12-year-old school children is poor. More emphasis has to be given school based and community based oral health promotion and preventive programmes.

Causes of adverse pregnancy outcomes and the role of maternal periodontal status - a review of the literature

Preterm (PT) and Low birth weight (LBW) are considered to be the most relevant biological determinants of newborn infants survival, both in developed and in developing countries. Numerous risk factors for PT and LBW have been defined in the literature. Infections of the genitourinary tract infections along with various biological and genetic factors are considered to be the most common etiological factors for PT/LBW deliveries. However, evidence suggests that sub-clinical infection sites that are also distant from the genitor-urinary tract may be an important cause for PT/LBW deliveries. Maternal periodontal status has also been reported by many authors as a possible risk factor for PT and LBW, though not all of the actual data support such hypothesis. The aim of this paper is to review the evidence from various published literature on the association between the maternal periodontal status and adverse pregnancy outcomes. Although this review found a consistent association between periodontitis and PT/LBW, this finding should be treated with great caution until the sources of heterogeneity can be explained.

Maternal periodontal status and preterm delivery: a hospital based case-control study

BACKGROUND AND OBJECTIVE

Recent studies have presented evidence that periodontal disease in pregnant women may be a determining factor for preterm delivery. However, this finding has not been consistently observed. The present investigation was carried out to explore the association between maternal periodontal disease and preterm delivery in the state of Kerala, India.

MATERIAL AND METHODS

The case-control study had a sample of 300 (100 cases and 200 controls) postpartum women over 18 years of age. Cases were women who had undergone spontaneous preterm delivery (< 37 wk of gestation) and controls were women who delivered at term (≥ 37 wk of gestation). Standard, clinical and periodontal examinations were performed at the maternity wards, and the existence of an association between periodontal disease and preterm delivery was evaluated by means of a multivariate logistic regression model that also considered other risk factors for preterm delivery.

RESULTS

Periodontitis was diagnosed in 25% of the mothers in the case group and in 14.5% of the mothers in the control group. Logistic regression analysis indicated a risk of nearly threefold for preterm delivery in mothers with periodontitis [adjusted odds ratio (OR(a) ) = 2.72; 95% confidence interval (CI): 1.68-6.84]. The other factors significantly associated with preterm birth were physical exertion (OR(a) = 2.80; 95% CI: 1.18-6.65), a previous history of preterm birth (OR(a) = 2.65; 95% CI: 1.20-5.83) and previous abortion/death of infant (OR(a) = 4.08; 95% CI: 1.56-10.65).

CONCLUSION

Periodontal disease is a possible risk factor for preterm delivery in this population.